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Voices on adherence to ART in Ethiopia and Uganda: a matter of choice or simply not an option?

机译：关于在埃塞俄比亚和乌干达遵守抗逆转录病毒疗法的声音：是选择问题还是根本没有选择？

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This paper explores HIV patients' adherence to antiretroviral treatment (ART) in resource-limited contexts in Uganda and Ethiopia, where ART is provided free of charge. Qualitative semi-structured interviews were conducted with 79 patients, 17 peer counselors, and 22 providers in ART facilities in urban and rural areas of Ethiopia and Uganda. Interviewees voiced their experiences of, and views on ART adherence both from an individual and a system level perspective. Two main themes emerged from the content analysis: "Patients' competing costs and systems' resource constraints" and "Patients' trust in ART and quality of the patient-provider encounters." The first theme refers to how patients' adherence was challenged by difficulties in supporting themselves and their families, paying for transportation, for drug refill and follow-up as well as paying for registration fees, opportunistic infection treatment, and expensive referrals to other hospitals. The second theme describes factors that influenced patients' capacity to adhere: personal responsibility in treatment, trust in the effects of antiretroviral drugs, and trust in the quality of counseling. To grant patients a fair choice to successfully adhere to ART, transport costs to ART facilities need to be reduced. This implies providing patients with drugs for longer periods of time and arranging for better laboratory services, thus not necessitating frequent revisits. Services ought to be brought closer to patients and peripheral, community-based healthworkers used for drug distribution. There is a need for training providers and peer counselors, in communication skills and adherence counseling.
机译：本文探讨了乌干达和埃塞俄比亚在资源有限的情况下艾滋病毒患者对抗逆转录病毒治疗（ART）的依从性，那里免费提供抗逆转录病毒治疗。在埃塞俄比亚和乌干达的城乡地区，对79名患者，17名同伴咨询者和22名抗逆转录病毒治疗提供者进行了定性半结构化访谈。受访者从个人和系统角度表达了他们对抗逆转录病毒疗法依从性的经验和看法。内容分析产生了两个主要主题：“患者的竞争成本和系统的资源限制”和“患者对ART的信任以及患者与提供者的相遇质量”。第一个主题是如何在以下方面挑战患者的依从性：在养育自己和家人时遇到困难，难以支付交通，药物补充和后续费用，以及支付挂号费，机会性感染治疗和昂贵的转诊费用。第二个主题描述了影响患者依从性的因素：治疗中的个人责任，对抗逆转录病毒药物作用的信任以及对咨询质量的信任。为了使患者有成功选择抗逆转录病毒疗法的合理选择，需要减少抗逆转录病毒治疗设施的运输费用。这意味着要为患者提供更长的药物使用时间，并安排更好的实验室服务，因此无需经常进行复诊。服务应更靠近患者和用于分发药物的社区周边社区卫生工作者。需要在交流技巧和依从性咨询方面培训提供者和同伴咨询者。

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